Neurosurgery in Paris from 1933 to 1940

Russian Postgraduate Medical Academy, Moscow, Russia

There is a surprising discrepancy between the leading position of French neurology in the late 19th- early 20th century and the late development of neurosurgery (neurologie chirurgicale) in France. The idea of surgery of the nervous system as a specialty arrived before 1900. In 1896-1901 a surgeon Antoine Chipault edited six volumes of Travaux de Neurologie Chirurgicale et Ortopedie. However, the first cerebral tumour was operated upon in Paris in 1909 and first medullary tumour - as late as 1911 (both cases were diagnosed by J. Babinski) - about 25 years after the similar operations in UK by R. Godlee and V. Horsley).

There were two key figures in the development of neurosurgery clinic in France - Clovis Vincent (1879-1947) and Thierry de Martel (1876-1940). De Martel practiced at his private clinic at rue Versingetorix until his suicide in 1940 after German occupation of Paris. He operated under local anaesthesia in a sitting position. Clovis Vincent was a neurologist who worked together with de Martel for many years. In 1927 he spent less than a month with Cushing and in 1928 at the age of fifty made his first neurosurgical intervention (when de Martel was absent). That was the end of their friendship. In 1933 a first neurosurgical department was created at la Pitiè. It was headed by Clovis Vincent, who was a neurologist without any formal surgical training. Harvey Cushing watched Vincent operate in 1933 and later remarked: "You have in Paris someone who without doubt is the world's best neurosurgeon." In 1938 he made 491 big operations and mortality did not exceed 16% (at the earlier period the mortality in frontal lobe tumours achieved 60%). Vincent's idea was to create not only a centre of neurosurgical treatment but a research centre as well. He employed ophthalmologists, ENT doctors, and radiologists. For a six-year period (from 1933 until May 1939) 1435 ventriculographies and 2060 operations were performed. Neuropathology lab was headed by Prof. del Rio Hortega. In 1938 the neurosurgery department at la Pitiè was transformed into the Chair of a Neurosurgery Clinic (Chaire de Clinique neurochirurgicale) with the help of the Rockefeller Foundation. Vincent's pupils (M. David, P. Puech, G. Guiot and others) later became leading French neurosurgeons.

The early stages of neurosurgery development in Paris provide us a remarkable example of the impact of international tendencies and national traditions on specialisation in modern medicine.

Session V -- Neuroscience Across the Centuries
Friday, 15 June 2001, 12:00 pm

Sixth Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and
Eighth Meeting of the European Club for the History of Neurology (ECHN)

Cologne, Germany